Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz / Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early.

INTRODUCTION: Pre-operative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA≤II were included for analysis and divided according to their post-operative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year post-operative mortality rates; 30-day post-operative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% versus 4.1%, p=.16) and 1-year post-operative (4.3% versus 16.3%, p=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% versus 16.3%, p=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year post-operative mortality indicators, as well as readmission for medical reasons.

Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz.

INTRODUCTION: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.

Pharmacokinetics of meloxicam after intravenous, intramuscular and oral administration of a single dose to African grey parrots (Psittacus erithacus).

Meloxicam is a nonsteroidal anti-inflammatory drug commonly used in avian species. In this study, the pharmacokinetic parameters for meloxicam were determined following single intravenous (i.v.), intramuscular (i.m.) and oral (p.o.) administrations of the drug (1 mg/kg·b.w.) in adult African grey parrots (Psittacus erithacus; n = 6). Serial plasma samples were collected and meloxicam concentrations were determined using a validated high-performance liquid chromatography assay. A noncompartmental pharmacokinetic analysis was performed. No undesirable side effects were observed during the study. After i.v. administration, the volume of distribution, clearance and elimination half-life were 90.6 ± 4.1 mL/kg, 2.18 ± 0.25 mL/h/kg and 31.4 ± 4.6 h, respectively. The peak mean ± SD plasma concentration was 8.32 ± 0.95 µg/mL at 30 min after i.m. administration. Oral administration resulted in a slower absorption (tmax  = 13.2 ± 3.5 h; Cmax  = 4.69 ± 0.75 µg/mL) and a lower bioavailability (38.1 ± 3.6%) than for i.m. (78.4 ± 5.5%) route. At 24 h, concentrations were 5.90 ± 0.28 µg/mL for i.v., 4.59 ± 0.36 µg/mL for i.m. and 3.21 ± 0.34 µg/mL for p.o. administrations and were higher than those published for Hispaniolan Amazon parrots at 12 h with predicted analgesic effects.

Long-lasting concentrations of cefovecin after subcutaneous and intramuscular administration to Patagonian sea lions (Otaria flavescens).

Cefovecin is a third-generation cephalosporin developed as an aqueous solution for use by the subcutaneous route in dogs and cats. This study evaluated the duration of cefovecin plasma concentrations after single intramuscular (IM) or subcutaneous (SC) injection at different doses in 10 Patagonian sea lions (Otaria flavescens). Blood samples were collected serially from the day of the injection up to 60-90 days post-injection. Plasma drug concentrations were determined by high performance liquid chromatography-UV detection and pharmacokinetic parameters were calculated by non-compartmental analysis. No reactions or side effects associated with the drug were observed in any of the studied animals. Both routes showed very similar pharmacokinetic behaviour. Elimination half-life (11.3-21.6 days, SC; 13.1-15.9 days, IM) and mean residence time (17.6-36.8 days SC; 16.5-25.4 days IM) were, in all cases and doses, considerably longer than those previously reported for any other species. Based on these findings, and preliminary data on specific pathogen sensitivity, cefovecin was found to be a very promising antimicrobial for Patagonian sea lions, in particular those that are difficult to access or that are under certain rehabilitation conditions.

Electrophoretic deposition of ZnO/alginate and ZnO-bioactive glass/alginate composite coatings for antimicrobial applications.

Two organic/inorganic composite coatings based on alginate, as organic matrix, and zinc oxide nanoparticles (n-ZnO) with and without bioactive glass (BG), as inorganic components, intended for biomedical applications, were developed by electrophoretic deposition (EPD). Different n-ZnO (1-10 g/L) and BG (1-1.5 g/L) contents were studied for a fixed alginate concentration (2 g/L). The presence of n-ZnO was confirmed to impart antibacterial properties to the coatings against gram-negative bacteria Escherichia coli, while the BG induced the formation of hydroxyapatite on coating surfaces thereby imparting bioactivity, making the coating suitable for bone replacement applications. Coating composition was analyzed by thermogravimetric analysis (TG), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS) analyses. Scanning electron microscopy (SEM) was employed to study both the surface and the cross section morphology of the coatings. Polarization curves of the coated substrates made in cell culture media at 37 °C confirmed the corrosion protection function of the novel organic/inorganic composite coatings.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. / Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera.

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera / Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty

Paciente varón de 76 años, con antecedente de implantación de prótesis total de cadera tipo Perfecta (Orthomet®), que consulta por masa en fosa ilíaca, con aumento del diámetro del muslo y dolor flexión y extensión de la cadera. Los estudios complementarios de ecografía y tomografía evidencian la presencia de una tumoración quística gigante lobulada en fosa ilíaca izquierda de unos 7cm de diámetro en la proximidad de la prótesis. La formación quística ocasionada por la enfermedad del polietileno tras la colocación de una artroplastia total de cadera es poco frecuente. Presentamos un caso de bursitis del psoas de gran tamaño, secundaria a la liberación de partículas del polietileno, que ocasionó compresión y trombosis de la vena femoral superficial (AU)

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein (AU)

[Superficial femoral vein thrombosis due to large psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de vena femoral superficial por bursitis del psoas posterior a artroplastía total de cadera.

Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.

[Thrombosis of the superficial femoral vein due to psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de la vena femoral superficial por bursitis del psoas secundaria a enfermedad de las partículas en artroplastía total de cadera.

The case of a male 76 year-old patient with a history of total hip replacement surgery is presented herein. The patient had tumors in the iliac fossa with swelling of the thigh and pain upon hip flexion and extension. The complementary ultrasound and computed tomography show a large lobed cystic tumor in the left iliac fossa, 7 cm in diameter, close to the prosthesis. The diagnosis was psoas bursitis secondary to the release of polyethylene particles that caused compression and thrombosis of the superficial femoral vein. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent.

Artrodesis tibioastragalocalcánea con clavo intramedular retrógado / Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail

Introducción: El objetivo es valorar los resultados de los pacientes intervenidos de artrodesis tibioastragalocalcánea con clavo intramedular retrógrado. Material y métodos: Se presentan 8 pacientes con una edad media de 60 años con afectación de las articulaciones tibioastragalina y subastragalina con alteración importante de la marcha y dolor intenso, secundarias a artrosis primaria o postraumáticas, seudoartrosis de una artrodesis previa o deformidad grave secundaria a accidente cerebrovascular. Se trató a los pacientes mediante artrodesis tibioastragalocalcánea con clavo intramedular retrógrado, con valoración de los resultados funcionales antes y después de la cirugía, según los criterios de la AOFAS (American Orthopaedic Foot and Ankle Society). Resultados: El seguimiento medio fue de 32 meses (rango: 7 a 61), y los resultados fueron muy satisfactorios, con una puntuación media de 88,6 puntos. Resultados: El tiempo medio de consolidación fue de 18,3 semanas. Las complicaciones más frecuentes fueron una leve necrosis cutánea de los bordes de la herida, una úlcera plantar resuelta con tratamiento conservador y una discrepancia de longitud de 2 cm. Conclusión: La artrodesis tibiotalocalcánea con clavo retrógrado puede ser una técnica excelente en pacientes con afectación grave de las articulaciones tibioastragalina y subastragalina que no respondan al tratamiento conservador y como cirugía de rescate en aquellas técnicas de artrodesis que hayan fracasado previamente (AU)

Introduction: The purpose of this study is to assess the results of patients subjected to a tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. Materials and methods: We studied 8 patients of a mean age of 60 years that showed involvement of the tibiotalar and subtalar joints with significant gait alterations and acute pain, secondary to either primary or post-traumatic arthritis or pseudoarthrosis of a previous arthrodesis. There was also one case of a severe deformity secondary to acute stroke. Patients were treated by means of tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The AOFAS scale was used to assess functional results before and after surgery. Results: Mean follow-up was 32 months (range: 7–61). Overall results were highly satisfactory, with a mean score of 88.6 points. Results: Healing occurred alter a mean 18.3 weeks. The most frequent complications were an instance of mild skin necrosis at the edges of the wound, a plantar ulcer that resolved with conservative treatment and a leg length discrepancy of 2cm.ConclusionTibiotalocalcaneal arthrodesis with a retrograde nail can be an excellent technique for patients with severe involvement of the tibiotalar and subtalar joints who are unresponsive to conservative treatment. It can also be used as salvage surgery in previously failed arthrodesis procedures (AU)

Influence of peritoneal fluid on the expression of angiogenic and proteolytic factors in cultures of endometrial cells from women with endometriosis.

BACKGROUND: Endometriosis, defined as the presence of endometrium outside the uterus, is one of the most frequent benign gynaecological diseases. It has been suggested that both endometrial and peritoneal factors, related to angiogenesis and proteolysis, can be implicated in this disease. The aim of this study was to evaluate the influence of peritoneal fluid on the expression of angiogenic and proteolytic factors in cultures of endometrial cells from women with and without endometriosis. METHODS: Endometrial cells were isolated, cultured and treated with endometriotic or normal peritoneal fluid. Vascular endothelial growth factor-A (VEGF-A), urokinase plasminogen activator (uPA), matrix metalloproteinase-3 (MMP-3) and their inhibitors including thrombospondin-1, plasminogen activator inhibitor-1 and MMP inhibitor type 1 (TIMP-1) mRNA levels were evaluated by quantitative RT-PCR, and protein levels were quantified by ELISA. RESULTS: Peritoneal fluid from women with endometriosis induced an increase in VEGF-A and uPA protein and VEGF-A mRNA and uPA mRNA levels in endometrial cell culture from women with (P < 0.01) and without endometriosis (P < 0.05). The highest levels of VEGF-A and uPA were observed in endometrial cell cultures from patients with endometriosis and treated with peritoneal fluid from women with endometriosis. CONCLUSIONS: Peritoneal fluid from women with endometriosis induced more VEGF and uPA expression in endometrial cell culture from women with endometriosis than did normal peritoneal fluid. Endometrial-peritoneal interactions increased angiogenic and proteolytic factors in endometrial cells, which could contribute to the development of endometriotic lesions.

Expression of angiogenic factors in endometriosis: relationship to fibrinolytic and metalloproteinase systems.

BACKGROUND: Endometriosis is a highly prevalent, benign disease in which the angiogenic, fibrinolytic and metalloproteinase (MMP) systems may be implicated. The objective of this study is to analyse mRNA expression and protein levels of several angiogenic factors and to correlate them with several components of the fibrinolytic and MMP systems in samples from 71 women with endometriosis and 50 controls. METHODS AND RESULTS: Eutopic endometrium showed higher mRNA expression of vascular endothelial growth factor (VEGF) in patients than in controls. However, ovarian endometrioma had lower VEGF mRNA levels than did the eutopic endometrium of patients. Similar results were obtained for VEGF protein levels. On the other hand, a significant increase in thrombospondin-1 (TSP-1) levels was observed in ovarian endometrioma than in eutopic endometrium. The peritoneal fluid from women with endometriosis showed a significant increase in VEGF, urokinase-type plasminogen activator (uPA) and MMP-3 levels than that of controls. A significant correlation was observed between the levels of VEGF and uPA in endometrium and in peritoneal fluid. CONCLUSIONS: Endometrium and peritoneal fluid from women with endometriosis have increased levels of VEGF, uPA and MMP-3 levels. Therefore, the development of endometriotic implants at ectopic sites may be facilitated, promoting the progress of the endometriosis.

La histerectomía total laparoscópica en pacientes con patología benigna / Total laparoscopic hysterectomy in patients with benign pathology

Se revisan en este capítulo la técnica e indicaciones de la histerectomía laparoscópica

Indications and technical procedure of laparoscopic hysterectomy are reviewed in this chapter

Expression of the fibrinolytic components in endometriosis.

Endometriosis is a benign gynaecologic disease defined as the presence of endometrial tissue outside the uterus. This tissue has the ability to implant at ectopic sites, such as ovary and peritoneum, where a local extracellular proteolysis might take place. An altered expression of several components of the fibrinolytic system in the endometrium and peritoneal fluid of women with the disease has been suggested as a key factor in the establishment of the endometriotic lesions. There is evidence of increased fibrinolytic activity in the eutopic endometrium of these women, resulting in endometrial fragments with a high potential to degrade the extracellular matrix and facilitate implantation. Proteolytic status is determined by the imbalance between plasminogen activators and plasminogen activator inhibitors, which are expressed differently depending on the type of lesion considered and the stage of the disease. The aim of the present study is to review the expression of the plasminogen activator system in endometriosis, and to consider the clinical implications and the possible further research efforts in this disease.

mRNA analysis of several components of the plasminogen activator and matrix metalloproteinase systems in endometriosis using a real-time quantitative RT-PCR assay.

BACKGROUND: The plasminogen activator (PA) and matrix metalloproteinase (MMP) systems are implicated in the establishment of endometriosis. The mechanisms by which these systems are involved in the pathogenesis of this disease are not well defined and controversial results have been published. The aim of this study was to analyse mRNA and protein levels of several components of the PA and MMP systems in endometriotic tissue and endometrium from women with and without endometriosis. METHODS AND RESULTS: Real-time quantitative RT-PCR assays were developed to quantify mRNA levels of these components in 57 women with endometriosis and 32 controls. Endometrium of women with endometriosis showed higher mRNA and antigenic levels of urokinase type-PA (uPA) and MMP-3 than endometrium from controls. In these patients, ovarian endometriotic tissue had higher mRNA and antigenic levels of PA inhibitor type 1 (PAI-1) and MMP inhibitor type 1 (TIMP-1) than endometrium. CONCLUSIONS: The increase in mRNA and protein levels of uPA and MMP-3 observed in endometrium of women with endometriosis may facilitate the attachment of endometrial tissue to the peritoneum and ovarian surface, as well as the invasion of the extracellular matrix. This process would lead to the formation of early endometriotic lesions. Once the ovarian endometriotic cyst is developed, PAI-1 and TIMP-1 would increase which could explain the frequent clinical finding of an endometrioma without invasion of the adjacent ovarian tissue.

Tratamiento del hallux valgus mediante osteotomía de ensamblaje (scarf) / Treatment of hallux valgus by scarf osteotomy

Objetivo. Valorar los resultados tras la osteotomía en scarf para el tratamiento del hallux valgus. Material y método. Se revisaron 34 pacientes (44 pies), con una edad media de 52 años, que presentaron hallux valgus dolorosos y fueron intervenidos mediante la técnica en scarf, con un tiempo de seguimiento postoperatorio de 30 meses (19-42). Clínicamente fueron evaluados según la escala de Groulier y radiológicamente se valoraron los ángulos metatarsofalángico (MTF), intermetatarsal (M1-M2), articular metatarsal distal (DMAA), de apertura del antepié (M1-M5) interfalángico (IF); mediante un cuestionario se valoró el resultado subjetivo por parte del paciente. Para el análisis estadístico se empleó el paquete SPSS. Resultados. Los resultados subjetivos fueron mejores que los clínicos. La puntuación media final en la escala de Groulier fue de 56,9 puntos (máximo 70 puntos); los resultados favorables (> 49 puntos) fueron del 79,6 por ciento. La edad de los pacientes no influyó en el resultado final. Hubo mejoría en todos los parámetros radiológicos. Encontramos una correlación estadísticamente significativa (p = 0,05) entre el ángulo M1-M2 preoperatorio y el resultado final según Groulier. Se encontró una correlación entre una mayor corrección del DMAA y un mejor resultado clínico, si bien no fue estadísticamente significativa. Conclusión. La osteotomía en scarf del primer metatarsiano constituye una excelente opción terapéutica para el tratamiento del hallux valgus, destacando como mayores ventajas su versatilidad y la estabilidad primaria que proporciona (AU)